CAJ | 학술논문

目的探讨胰十二指肠切除术改进胰肠及胃肠吻合方式对患者近期和远期并发症的影响。方法对52例行胰十二指肠切除术的患者进行消化道重建，方式为胰肠、胆肠和胃肠顺序。胰肠吻合在完成胰十二指肠切除后，游离胰腺残端2.5～3.0 cm，将准备与胰腺吻合的空肠袢断端浆肌层剥除，制成黏膜瓣，长度与胰腺断面前后径相当，施行黏膜瓣覆盖胰腺断面的套叠式胰空肠端端吻合术；胃肠吻合是在胃或十二指肠球部与胰胆侧肠袢之间间置30 cm空肠施行胃肠道重建。结果术后发生胰漏2例（3.8%），经充分引流并给予生长抑素、肠内营养等保守治疗愈合，无腹腔感染及大出血等严重并发症。术后随访3年，随访率为88.5%（46/52），术后半年95.0%（38/40）的患者消化吸收功能基本正常，营养状况良好，未发生逆行性胆管炎、胆汁反流性胃炎、胃肠吻合口溃疡。结论施行胰十二指肠切除消化道重建过程中，采用黏膜瓣覆盖胰腺断面的套叠式胰空肠端端吻合术有助于减少胰漏等近期并发症；在胃或十二指肠球部与胰胆侧肠袢之间间置空肠，可减少胃肠道反流等远期并发症。
목적탐토이십이지장절제술개진이장급위장문합방식대환자근기화원기병발증적영향。방법대52례행이십이지장절제술적환자진행소화도중건，방식위이장、담장화위장순서。이장문합재완성이십이지장절제후，유리이선잔단2.5～3.0 cm，장준비여이선문합적공장번단단장기층박제，제성점막판，장도여이선단면전후경상당，시행점막판복개이선단면적투첩식이공장단단문합술；위장문합시재위혹십이지장구부여이담측장번지간간치30 cm공장시행위장도중건。결과술후발생이루2례（3.8%），경충분인류병급여생장억소、장내영양등보수치료유합，무복강감염급대출혈등엄중병발증。술후수방3년，수방솔위88.5%（46/52），술후반년95.0%（38/40）적환자소화흡수공능기본정상，영양상황량호，미발생역행성담관염、담즙반류성위염、위장문합구궤양。결론시행이십이지장절제소화도중건과정중，채용점막판복개이선단면적투첩식이공장단단문합술유조우감소이루등근기병발증；재위혹십이지장구부여이담측장번지간간치공장，가감소위장도반류등원기병발증。
Objective To investigate the effect of modified pancreatico-jejunal and gastrointestinal anastomosis for short- and long-term complications after pancreaticoduodenectomy. Methods Digestive tract was rebuilt in fifty-two patients undergoing pancreaticoduodenectomy in the order of pancretico-jejunal, biliary ductal junction and gastrointestinal anastomosis. After pancreaticoduodenectomy, the pancreatic stump was freed from the surrounding vessels and structures for a length of 2.5-3.0 cm. A jejunal loop was prepared for the pancreatico-jejunal anastomosis by removing the seromuscular layer where it would be anastomosed. The length of intestinal mucosal flap corresponded to anteroposterior diameter of pancreatic stump. An end to end pancreatico-jejunal anastomosis was then performed for covering surface of pancreatic stump with intestinal mucosal flap and duct-to-mucosal anastomosis. Gastrointestinal anastomosis was carried out in the 30 cm between the gastric-remnant or duodenal bulb and pancreatic biliary side bowel loops. Results Two cases (3.8%) of pancreatic leakage were observed, and were cured by administration of adequate drainage, somatostatin, enteral nutrition and so on. Postoperative serious complications such as abdominal infection or heavy bleeding were not observed. For a three-year follow-up, the rate of generally normal digestion and absorption function was 95.0%(38/40). All the patients were free from the long-term complications, like retrograde infection of biliary tract, bile reflux gastritis or gastrointestinal anastomotic ulcer.Conclusions Pancreatico-jejunal invagination anastomosis may reduce short-term complications of potential anastomotic, covering surface of pancreatic stump with intestinal mucosal flap and duct-to-mucosal anastomosis in alimentary tract reconstruction. Jejunal interposition between the gastric-remnant or duodenal bulb and pancreatic biliary side bowel loops in the reconstruction of gastrointestinal tract can reduce the incidence of long-term complications caused by gastrointestinal reflux.